Is it true that I can no longer speak after laryngeal cancer surgery?

The larynx is an important vocal organ. After laryngeal cancer surgery, many patients are worried about whether they can still speak after the surgery. In fact, this is mainly determined by the scope of laryngeal cancer lesions and the surgical method. In the early stage of laryngeal cancer, minimally invasive surgical methods have certain application value, and patients can speak normally without hindrance after surgery; if laryngeal cancer is in the middle stage or above, partial resection of the vertical larynx and frontal larynx is required. Such patients can speak after surgery, but their voices are hoarse; in the late stage of laryngeal cancer, there are certain requirements for total laryngectomy, and patients cannot pronounce normally after surgery. But please don’t worry, hoarseness after partial laryngectomy can be restored as soon as possible through later voice training. Even if patients cannot use the larynx to pronounce after total laryngectomy, esophageal pronunciation training, artificial larynx, implanted pronunciation buttons, and even the latest scientific and technological inventions can be used to help patients pronounce in the later stage. Next, I will answer the question about how to pronounce after laryngeal cancer surgery.

1. How to pronounce after partial laryngectomy?

After hemi-laryngectomy and partial laryngectomy, if the swallowing function improves, the tracheal cuff can be removed. However, before removal, the tracheal cuff should be blocked for 24-48 hours. If the patient does not have breathing difficulties, the cuff can be removed. For partial laryngectomy, the vocal cords of the patient will be affected to a certain extent, causing hoarseness, but it will not affect other speaking and breathing functions, and will not hinder the patient's normal life. For problems with the voice, voice training is a very effective treatment method. The principle is to enable patients to fully learn and use scientific vocalization methods to compensate for the healthy vocal cords, increase the elasticity of the vocal cords, and promote vocal cord closure, thereby improving the patient's pronunciation quality and improving the abnormal state of the voice. It is a non-invasive treatment method with the characteristics of low cost, simple operation, non-invasiveness and high patient acceptance.

2. How to pronounce after total laryngectomy?

There are currently four common ways of speaking for patients who have undergone total laryngectomy. Here is a brief introduction:

First, esophageal pronunciation: For esophageal pronunciation, pronunciation can be improved and restored without the use of tools or surgery, and it can communicate with people anytime and anywhere without restrictions, which is favored by the majority of patients. The basic principle of pronunciation is to use the intrathoracic pressure to force out the air in the esophagus like burping, forming an effective impact force on the upper end of the esophagus or the pharyngeal mucosa, and then pronounce. When inhaling, the negative pressure in the esophagus can provide great convenience for air to be pressed into the esophagus, and then practice abdominal muscle contraction to help the diaphragm rise and increase intrathoracic pressure. After the air is discharged from the upper mouth, the pronunciation can be made. Generally, beginners can master it after practicing for 1-2 weeks, and after continuous practice, the esophageal pronunciation will become more and more fluent and natural. This kind of pronunciation training generally has a special training course. For example, the Cancer Hospital of the Chinese Academy of Medical Sciences has successfully held esophageal pronunciation training for 30 years, helping more than 1,000 patients to rebuild their language function and enabling more and more laryngeal patients to rebuild a bridge of communication with the outside world.

Second, artificial larynx: If esophageal sound training does not achieve good implementation results, the application of artificial larynx is also quite significant. It makes the airflow from the lungs pass through the artificial larynx to pronounce, and then the airflow enters the oral pronunciation part to meet the needs of collaborative work. Analyzing its advantages, it can ensure the clarity of pronunciation, but because of the influence of carrying an artificial larynx device, the tubes at both ends of the pronunciation device should be connected to the oral cavity, and its operation convenience is relatively low. However, during the operation, the sound generator is easily contaminated, and the patient should constantly standardize the specific cleaning and disinfection steps.

Third, electronic larynx: As one of the important electronic generators, its composition is mainly due to transistors. When speaking, electrical energy will complete the corresponding conversion process into sound energy. This method is not difficult to use. Just place it under the mandible, but the sound it makes is similar to the sound of a robot. Sometimes the pronunciation is difficult to understand, and many patients are somewhat repulsive to this sound.

Fourth, the implantable pronunciation button is a one-way valve placed between the esophagus and the trachea through surgery. It allows air to pass through and be delivered to the pharynx, while preventing liquid and food from entering the esophagus in the opposite direction, forming a one-way channel between the esophagus and the trachea. When the neck stoma is blocked, the air will be guided to the esophagus and pharynx, thereby generating vibrations and making sounds. This implantable pronunciation button provides patients with a more fluent and natural pronunciation method than other methods after total laryngectomy. It has high pronunciation quality, loud voice, coherent pronunciation, long duration, and is easy to master. It is the international gold standard for voice reconstruction after laryngectomy and has been widely used abroad. However, there are certain risks in the implantation of pronunciation buttons. Patients may need to undergo multiple placement surgeries due to poor placement, and may also cause accidental injuries such as mucosal damage, infection, scar obstruction of the airway, and swallowing. Therefore, it has not been widely used in China.

3. The latest wearable throat technology

Recently, a wearable artificial larynx has emerged. It plays an important role and advantage in identifying the signals of the wearer's throat, and converts the identified signals into speech with a very high restoration accuracy. Its research and development materials mainly benefit from graphene materials. Its sensitivity is prominent in low-frequency muscle movements, high-frequency sound wave information, etc., and its speech perception ability is strong, and its anti-noise effect cannot be underestimated. At the same time, with the support of the thermoacoustic effect, the artificial larynx can achieve a smooth transition and conversion of signals to sound playback. By integrating AI models, the artificial larynx is very suitable for practice and application in identifying vague words spoken by laryngectomy patients. Its accuracy rate is often above 90%. After synthesis, the recognized content will be converted into speech, and then played on the artificial larynx, so that the patient's voice communication ability is significantly improved, thereby providing a strong guarantee for people with sound disorders. Regarding the production process of artificial larynx, its simplicity, performance stability and other properties have outstanding advantages. As one of the new hardware platforms, it has a crucial impact on speech recognition and interaction. Moreover, compared with implanted pronunciation buttons, this pronunciation device is non-traumatic to patients. It is indeed a blessing for the majority of patients without larynx. The technology is currently recruiting suitable patients for clinical debugging stage, and it is hoped that it will bring "new voice" to the majority of patients.

Technology is constantly improving. For the future application of artificial larynx, the distance between the artificial larynx and the voice-impaired should be continuously strengthened, while achieving the fundamental purpose of voice interaction. It is not only to restore the voice problems of the voice-disabled groups, but in fact, it can also be applied to ordinary people to meet their communication needs in special occasions. (Li Yan, Cancer Hospital, Chinese Academy of Medical Sciences)